Provider Demographics
NPI:1831750561
Name:VOLLMER, BRIAN P (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:VOLLMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 PHYLISS LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9031
Mailing Address - Country:US
Mailing Address - Phone:704-568-8010
Mailing Address - Fax:
Practice Address - Street 1:5833 PHYLISS LN
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9031
Practice Address - Country:US
Practice Address - Phone:704-568-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93841223G0001X
NC121001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12100OtherNC BOARD OF DENTISTRY